Permit , CITY OF TIGARD MECHANICAL PERMIT
COMMUNITY DEVELOPMENT Permit #: MEC2012 -00050
TIGARD 13125 SW Hall Blvd., Tigard OR 97223 503.718.2439 Date Issued: 01/26/2012
Parcel: 2S104AA14300
Jurisdiction: Tigard
Site address: 12150 SW 128TH AVE
Project: Zapp Subdivision: BELLWOOD NO.3 Lot: 162
Project Description: Replace furnace.
Contractor: COLUMBIA HEATING & COOLING INC Owner: ZAPP, MICHAEL J & CAROLEE A
PO BOX 230397 12150 SW 128TH AVE
TIGARD, OR 97281 TIGARD, OR 97223
PHONE: 503 - 624 -2704 PHONE: 503 - 520 -6225
FAX: 503 - 598 -0270
FEES
Specifics: Description Date Amount
Furnaces < 100K BTU 01/26/2012 $46.75
Type of Use: SF 12% State Surcharge - Mechanical 01/26/2012 $10.80
Class of Work: ALT Type of Const: Minimum Fee Adjustment - Mechanical 01/26/2012 $43.25
Occupancy Grp:
Stories:
Fuel
Fuel Types:
Gas Pressure:
Total $100.80
Required Items and Reports (Conditions)
This permit is issued subject to the regulations contained in the Tigard Municipal Code, State of OR. Specialty Codes and all other
applicable law. All work will be done in accordance with approved plans. This permit will expire if work is not started within 180 days of
issuance, or if work is suspended for more the 180 days. ATTENTION: Oregon law requires you to follow the rules adopted by the Oregon
Utility Notification Center. Those rules are set forth in OAR 952- 001 -0010 through OAR 952 -001 -0090. You may obtain a copy of the rules
or direct questions to OUNC by calling 503.232.1987 or 1.800.332.2344.
Issued By: Geat2 Permittee Signature: o y „0,./
Call 503.639.4175 by 7:00 a.m. for the next available inspection date.
This permit card shall be kept in a conspicuous place on the job site until completion of the project.
Approved plans are required on the job site at the time of each inspection.
Jan 24 12 12:04p Columbia Heating /Cooling 503- 598 -0270 p.2
Mechanical Permit Application F OR O F FICI USE ON1,Y
City of Tigard , Received
13125 5W Hall Blvd.. 'Tigard, OR 97223
C Phone: SC3 "713.2439 Fax: 5{13.59 0.,:,
^ Plait Review
od:er Permit:
Inspection Line: 503,639.4175 r � �`L Crate /Ey:
T L R t A l Date Rcadyilly: reds: i El See Page 2 for
Internee wtvu.tigard•or.gnv 3 l' o(.Ired ` Supplemendal rtdormation
• .P � pN . � ` � P ,O t k
.. T E OF :W ORRG : _ . 1\ \ ` COMMERCIAL FEE SCHEDULE - USE CHECKLIST
❑ New construction dditionialterationt \\ ( Mechanical permit fees" are hased no the value of the work
per formed, Indicate the value (rounded 10 the nearest dollar) of all
E 0 Demolition ❑ Other: V\‘" mechanical moterinls, equipment, labor, overhead, and profit.
..CAT 6ORY ti tF..COMSTi1:3GTIOy' -.; -
Value: S
RESIDENTIAL EQUIPMENT I SYSTEMS FEES``
1- and 2- family dwelling 0 Commercial/industrial ❑ Accessory building For special inform USNClieckfrsL
. ❑ Multi-family ❑ Master builder ❑ Other: L Description
1 Qq•.1 Ea. I Total
, JOB SITE- Il4'FORMATTON.AND. LOCATION - . i ileatine�/coolinq:
4 - / N � Air conditioning
, Job Site address: it ). ii' , y (' )..1.2.,_,1 ! rd r , ("erutrer `:le plan eho.■l e pl:wtrnent) 46.7S
�G i
City /StateiZTP: l rt �Gi,r Cie +=� r f Furnace 100.000BT11Idaineciis) 46 -75
Z /
-1 Furnace 100.000- R t'I,1 (c/ s) 54.91
Scite bidg.:apt. no.: Project name: 71,, (lent pump
(rcyait'ce sae Man sltcr+ingplacement) 61.06
Cross street/directions to job site: Duct wo rk 23_31
ti
i fydrollic hot water system 2 132
Residential boiler (radiator or
1 iwdfonlc) 23.32
i Unit heaters (fuel -type, not electric).
in -wall. in -duct, suspended. etc. _ 46,75 __
Subdivision: Lot no.: flue /vent for any of above 23
t Other: 23.32
m
Tax ap/panxl no.:
Other fuel appliances:
• ' : : UESCRIPI"'iQN: OF; • WORK : . • Water healer 23.32
-�„� " Gas fireplace
33.39
' t:-4 r:: fizr.4-:.,_ ' < /7 Flue vent for w•a :er heater or gas I
fireplace 23.32
Log lighter (gas) 23.32:
Wood /pellet stove 33
Wood $replace /insert 23.32
PROPERTY OWNER. 23 I
Name: Chimneyilinerfflueivent 23.32 •
/ j Other: i ,
! •/ /tt~!- //:t c G- -7F‘",
Environmental exhaust and ventilation:
Address: ! f G �`' ) i 49
A Range hncldklhcr kitchen
' J �..� l�' Lie: - equipment i
33.39
City1S atc!3 -.1P:
f Gi id% f` : tt~ i 7t2 ;2) Clothes dryer exhaust 33.39
Phone: (51',i-' ) — r) 1 F ( ) Single -duct exhaust.(haihrooms.
C. w 0 v(ol toilet compartments, utility rooms), i 23.32
® APPLICANT -, YTA
•
C4CT:,PERS4 rlttic /crawlspaoe tens 23.:2
H )sin s name: Columbia h eating and Cooling, - Other 23.32
_.. Fuel piping:
Contact. name: Marlena hleetkttn 514.15 for first four; S-l.03 fa. each additional
Addre PO Box 239397 - Furnace, etc,
City /Stalep2IP: 97281 Gas heat puma
t Wallivtisnended/ unit heater
Phone: (503) 624 Fax: : (503) 598 - 0270 Water heater
r • Fireplace
F. -mail: columbhc @telcport,com
Range
'CONTRACTOR . - , Barbecue
Business name: Corm,' bra Ilea ting and Cooling, Inc. Clothes dryer (gay)
Address: t'() Boa 230397 .. Other:
— �_. --` -. - -- -.._, ME ..... - tEAI isER�i1TFEES* •
Citv enle:ZIP: Tigard, OR 97281 _- - -- Subtotal ; ^
Phone: {5031 624 -2704 Fax (503) 598 -0270 Minimum permit fee ( 90.00) trYa de/ti
Plan review ('25:Pofpemtit fee)
CCBtic.: State surcharge (1294 of permit feel /Q. 2/V
TOTAL PERMIT FEE , f 01
Authorized signature: ®� �� /'+� •rid, permit applica lion expires its permit is not obtained within 180
4. does after it has been accepted as complete.
Fruit name: Markna R lleedom Date: / ._ a (. ,2 s -ec i uthodnlogy del by Tri -Corny ttuiltting industry Service ROM)
•.v.,..n.r:P......... n.u'. P....w:•nm, An. ro,no:tn .u&alo: 1,r,,rrnv1a7n,